Topics Related to Medicaid Managed Care
Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.
The following policies will expire June 30, 2026. These include:
Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.
Action Required: Providers with Active 251S00000X Taxonomy must select New Service and Report National Accreditation.
Modifier CR should only be appended to procedure codes when services are directly related to a Federal or State-declared emergency or disaster.
The Centers for Medicare & Medicaid Services has released 80 new ICD-10-PCS codes, Effective April 1, 2026.
Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.
Evaluates the influence of NC Medicaid Transformation on primary care and obstetrics/gynecology practices that contract with NC Medicaid.
An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.
For NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State Funded Behavioral Health Providers.